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This multi-authored book covers most aspects of evaluation of gastrointestinal motility – a field that has been expanding in recent times largely due to advances in diagnostic modalities; coupled with this, new evidences supporting best practices have increased the interest among clinical gastroenterologists, researchers, teachers and trainees in gastrointestinal motility and its disorders. New advances in the field of evaluation of functional bowel diseases and motility disorders, such as high-resolution manometry, 24-h pH impedance monitoring, Bravo capsule pH-metry, barostat, balloon expulsion test, barium and MR defecography, biofeedback, hydrogen breath tests, motility capsule (smartpill) etc. have significantly expanded the scope and outcome of treating these disorders. The chapters have been contributed by a well-conversant group of experts from the global academia, including India, Singapore, Thailand, Korea and Australia, integrating the body of knowledge on evaluation methods with evidence of best practices for the management of motility disorders. A chapter on how to set-up a manometry laboratory provides key information for clinicians and researchers who are planning to start working in this area. With 11 chapters in the book supported with numerous tables, flow charts, schematic diagrams and images, professionals will find it an essential reading. ​
Three distinct types of contractions perform colonic motility functions. Rhythmic phasic contractions (RPCs) cause slow net distal propulsion with extensive mixing/turning over. Infrequently occurring giant migrating contractions (GMCs) produce mass movements. Tonic contractions aid RPCs in their motor function. The spatiotemporal patterns of these contractions differ markedly. The amplitude and distance of propagation of a GMC are several-fold larger than those of an RPC. The enteric neurons and smooth muscle cells are the core regulators of all three types of contractions. The regulation of contractions by these mechanisms is modifiable by extrinsic factors: CNS, autonomic neurons, hormones, inflammatory mediators, and stress mediators. Only the GMCs produce descending inhibition, which accommodates the large bolus being propelled without increasing muscle tone. The strong compression of the colon wall generates afferent signals that are below nociceptive threshold in healthy subjects. However, these signals become nociceptive; if the amplitudes of GMCs increase, afferent nerves become hypersensitive, or descending inhibition is impaired. The GMCs also provide the force for rapid propulsion of feces and descending inhibition to relax the internal anal sphincter during defecation. The dysregulation of GMCs is a major factor in colonic motility disorders: irritable bowel syndrome (IBS), inflammatory bowel disease (IBD), and diverticular disease (DD). Frequent mass movements by GMCs cause diarrhea in diarrhea predominant IBS, IBD, and DD, while a decrease in the frequency of GMCs causes constipation. The GMCs generate the afferent signals for intermittent short-lived episodes of abdominal cramping in these disorders. Epigenetic dysregulation due to adverse events in early life is one of the major factors in generating the symptoms of IBS in adulthood.
This issue of Gastroenterology Clinics of North America is on Gastrointestinal Motility Disorders. GI motility disorders are common reasons for patients to see gastroenterologists. Knowledge of the pathophysiology, evaluation and treatment of these disorders is important to appropriately care for patients with gastrointestinal motility disorders in clinical practice. The chapters of this issue will discuss key aspects of gastrointestinal motility disorders focusing on how they relate to practicing gastroenterologists and other health care providers. Current knowledge in the area as well as evolving concepts from clinical investigations and translational research from basic sciences will be discussed. The rapid explosion of new technology used in the evaluation of patients will be covered.
Clinical and Basic Neurogastroenterology and Motility is a state-of-the-art, lucidly written, generously illustrated, landmark publication that comprehensively addresses the underlying mechanisms and management of common adult and pediatric motility disorders. These problems affect 50% of the population and include conditions such as dysphagia, achalasia, gastroesophageal reflux disease, gastroparesis, irritable bowel syndrome (IBS), gas and bloating, SIBO, constipation and fecal incontinence. The book brings together international experts and clinician scientists, epitomizing their years of wisdom into a concise yet practical text that is delivered in two distinct sections, basic and clinical. It fulfills a large unmet need, and bridges a long-awaited knowledge gap among trainees, clinicians, scientists, nurses and technicians, earnestly engaged in this field. - First of its kind text that covers both basic and clinical aspects, bridging the knowledge gap, and providing a bench to bedside approach for management of common disorders - Discusses the latest concepts and basic principles of neurogastroenterology and motility, and how the gut and brain interact in the genesis of functional gastrointestinal and motility disorders - Provides an illustrated and practical text on hot topics written by leading adult and pediatric gastroenterology experts across the globe - Includes an accompanying more detailed web version of the text with free access to future podcasts
This book explains the pharmacological relationships between the various systems in the human body. It offers a comprehensive overview of the pharmacology concerning the autonomic, central, and peripheral nervous systems. Presenting up-to-date information on chemical mediators and their significance, it highlights the therapeutic aspects of several diseases affecting the cardiovascular, renal, respiratory, gastrointestinal, endocrinal, and hematopoietic systems. The book also includes drug therapy for microbial and neoplastic diseases. It also comprises sections on immunopharmacology, dermatological, and ocular pharmacology providing valuable insights into these emerging and recent topics. Covering the diverse groups of drugs acting on different systems, the book reviews their actions, clinical uses, adverse effects, interactions, and subcellular mechanisms of action. It is divided into 11 parts, subdivided into several chapters that evaluate the basic pharmacological principles that govern the different types of body systems. This book is intended for academicians, researchers, and clinicians in industry and academic institutions in pharmaceutical, pharmacological sciences, pharmacy, medical sciences, physiology, neurosciences, biochemistry, molecular biology and other allied health sciences.
Gastrointestinal motility has evolved from an esoteric laboratory tool into a sophisti cated diagnostic technique that is now widely used clinically to guide in management of complex gastrointestinal problems. Today, it is the most rapidly growing subspecialty within gastroenterology. Previously, many of the gastrointestinal motility problems were either ignored or attributed to a disturbance of "psyche." But with the growing knowledge and understanding of how a dysfunction of the gastrointestinal muscle and nerves can cause disease, we are at the threshold of a revolution in our approach to the diagnosis and treatment of gastrointestinal motility disorders. The purpose of this book is to serve as a useful, up-to-date reference manual and guide for the diagnostic and therapeutic approach towards common adult and pediatric gastrointestinal motility problems. In order to enhance the understanding of these disor ders, a problem-oriented approach has been chosen, and wherever possible the authors have provided clinical case scenarios to illustrate their message. The emphasis has been on how to diagnose and treat motility disorders rather than to provide an encyclopedic infor mation. The reference list at the end of each chapter should enable the enthusiast to seek further information. Some of the material presented in this book has been derived from the proceedings of the annual University ofIowa College of Medicine GI Motility Symposia.
​This book describes the causes and clinical management of functional gastrointestinal disorders in a readily understandable way, with the aid of many clear illustrations. The concrete and practical advice provided will be most helpful in the clinical practice of both the general practitioner and the medical specialist. Functional disorders of the gastrointestinal tract, such as gastroesophageal reflux disease, functional dyspepsia, and irritable bowel syndrome, are very common and chronic conditions. Despite the recent publication of many scientific papers on their diagnosis and treatment, much remains unclear, and management is still considered challenging. This practice-oriented book will be an ideal source of reliable up-to-date guidance for all who care for these patients.
Praise for the previous edition: "Extraordinary achievement … this volume stands on its own as a marvelous feat in bringing such a vast array of clear and coherent instruction to endoscopists at all skill levels."—Gastroenterology Written and edited by internationally renowned specialists, the third edition of Gastroenterological Endoscopy covers the entire spectrum of diagnostic and therapeutic procedures for the upper and lower GI tract while providing the latest overview of GI disorders. A great wealth of high-resolution photographs provides the visual information needed to confidently assess and diagnose mucosal lesions of the entire digestive tract. Significant advances in the field—both medical and technical—since the last edition are covered in comprehensive detail. Key Features: New panel of top international editors, continuing the tradition of excellence, depth, and breadth as originated by founding editors Classen, Tytgat, and Lightdale; list of contributing authors is a "who's who" of GI endoscopy Coverage of newest, advanced tools and techniques: gastric-POEMS, submucosal tunnel endoscopic resection (STER), lumen-apposing metal stents, "over-the-scope" clips, and much more More than 1,500 exquisite images Gastroenterological Endoscopy, third edition, surely deserves a prominent place in any complete endoscopy reference collection. Michael B. Wallace, MD, is Professor of Medicine at the Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida, USA Paul Fockens, MD, is Professor and Chair of the Dept. of Gastroenterology and Hepatology at the Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands Joseph Jao-Yiu Sung, MD, PhD, is Mok Hing Yiu Professor of Medicine and Director of the Institute of Digestive Diseases of The Chinese University of Hong Kong, Shatin, Hong Kong An award-winning international medical and scientific publisher, Thieme has demonstrated its commitment to the highest standard of quality in the state-of-the-art content and presentation of all its products. Founded in 1886, the Thieme name has become synonymous with high quality and excellence in online and print publishing.
Dietary Interventions in Gastrointestinal Diseases: Foods, Nutrients and Dietary Supplements provides valuable insights into the agents that affect metabolism and other health-related conditions in the gastrointestinal system. It provides nutritional treatment options for those suffering from gastrointestinal diseases including Crohn's Disease, Inflammatory Bowel Disease, Ulcerative Colitis and Allergies, among others. Information is presented on a variety of foods, including herbs, fruits, soy and olive oil, thus showing that changes in intake can change antioxidant and disease preventing non-nutrients and affect gastrointestinal health and/or disease promotion. This book serves as a valuable resource for biomedical researchers who focus on identifying the causes of gastrointestinal diseases and food scientists targeting health-related product development. - Provides information on agents that affect metabolism and other health-related conditions in the gastrointestinal tract - Explores the impact of composition, including differences based on country of origin and processing techniques to highlight compositional differences and their effect on the gastrointestinal tract - Addresses the most positive results from dietary interventions using bioactive foods to impact gastrointestinal diseases, including reduction of inflammation and improved function of organs